Carvedilol increases two-year survivalin dialysis patients with dilated cardiomyopathy: a prospective, placebo-controlled trial

J Am Coll Cardiol. 2003 May 7;41(9):1438-44. doi: 10.1016/s0735-1097(03)00241-9.


Objectives: We sought to evaluate the effects of carvedilol on mortality and morbidity in dialysis patients with dilated cardiomyopathy.

Background: Several lines of evidence support the concept that therapy with beta-blocking agents reduces morbidity and mortality in patients with congestive heart failure (HF), but the demonstration of such a survival benefit in dialysis patients with dilated cardiomyopathy is still lacking.

Methods: A total of 114 dialysis patients with dilated cardiomyopathy were randomized to receive either carvedilol or placebo in addition to standard therapy. A first analysis was performed at one year and was followed by an additional follow-up period of 12 months.

Results: Two-year echocardiographic data revealed a significant attenuation of pathologic remodeling, with smaller cavity diameters and higher ejection fractions in the active treatment group than in the placebo group. At two years, 51.7% of the patients died in the carvedilol group, compared with 73.2% in the placebo group (p < 0.01). Furthermore, there were significantly fewer cardiovascular deaths (29.3%) and hospital admissions (34.5%) among patients receiving carvedilol than among those receiving a placebo (67.9% and 58.9%, respectively; p < 0.00001). The exploratory analyses revealed that fatal myocardial infarctions, fatal strokes, and hospital admissions for worsening HF were lower in the carvedilol group than in the placebo group. A reduction in sudden deaths and pump-failure deaths was also observed, though it did not reach statistical significance.

Conclusions: Carvedilol reduced morbidity and mortality in dialysis patients with dilated cardiomyopathy. These data suggest the use of carvedilol in all dialysis patients with chronic HF.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Aged
  • Carbazoles / therapeutic use*
  • Cardiomyopathy, Dilated / drug therapy*
  • Cardiomyopathy, Dilated / etiology
  • Cardiomyopathy, Dilated / mortality*
  • Carvedilol
  • Female
  • Follow-Up Studies
  • Humans
  • Kidney Diseases / complications*
  • Kidney Diseases / mortality
  • Kidney Diseases / therapy*
  • Male
  • Middle Aged
  • Prognosis
  • Propanolamines / therapeutic use*
  • Prospective Studies
  • Renal Dialysis / mortality*
  • Survival Rate
  • Time Factors


  • Adrenergic beta-Antagonists
  • Carbazoles
  • Propanolamines
  • Carvedilol